- Email: [email protected]
GW26-e0675 Comparison of Ticagrelor with Clopidogrel in the Treatment of Patients with Acute Coronary Syndrome in Platelet Reactivity
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 66, NO. 16, SUPPL S, 2015
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OBJECTIVES Elevated remnant-lipoprotein cholesterol (RLP-C) levels are associated with an increased risk of ischemic heart disease. The concurrence of RLP-C measurement by different separation methods is not well-described. This analysis assessed RLP-C by 3 commonly used measurements including immunoseparation (IM [ApoA-I and ApoB-100 monoclonal antibodies]), vertical auto profile (VAP [IDLþVLDL3]) and Calculated RLP-C (Total cholesterol minus HDL-C minus LDL-C) methods using samples from a previously reported randomized, clinical trial.
GW26-e3950 Uninterrupted Dabigatran versus Warfarin in the Treatment of Intracardiac Thrombus in Patients with non-Valvular Atrial Fibrillation
METHODS This analysis assessed fasting RLP-C in hyperlipidemic patients (n¼2,382) treated with ezetimibe/simvastatin (E/S)10/20 mg, E/S þ niacin (N) 2g and N 2g during 24 weeks, and E/S 10/20 mg and E/S þ N 2g during 64 weeks. RLP-C levels, change from baseline and % change from baseline were evaluated by the IM, VAP, and Calculated methods. The relationships and agreement among the 3 methods used in the measurement of these parameters were assessed by Pearson correlation coefficients and Bland-Altman, respectively.
OBJECTIVES The oral direct thrombin inhibitor dabigatran has a predictable anticoagulant effect and may be an alternative medication to warfarin for non-valvular atrial fibrillation (AF) patients with intracardiac thrombus. The objective is to compare the dabigatran, administered at a fixed dose of 150 mg twice daily (bid) with dose-adjusted warfarin (with a target international normalized ratio INR level of 2.0 to 3.0).
RESULTS Cholesterol mass at baseline measured by the VAP and Calculated methods was w3-4X higher than by IM; all declined with treatment by 24 weeks with little further reduction at 64 weeks (see table). RLP-C change and % reduction from baseline were larger when measured by VAP versus Calculated and IM methods. Although the 3 methods were moderately to strongly correlated (r¼0.37-0.79) for RLP-C levels and changes, Bland-Altman plots showed little agreement between the methods for RLP-C levels but slightly better agreement for RLP-C changes (not shown). CONCLUSIONS RLP-C defined by IM, VAP and Calculated methods differs in mass and response to pharmacologic intervention. Given the relationship between RLP-C and IHD risk, standardization of methods is needed for RLP-C use in risk assessment.
GW26-e2366 Changes in Carotid Plaque Lipid Content in Subjects Who Continued and Discontinued Statin Therapy Ruixue Du, Ping Ye The Department of Geriatric Cardiology & Department of Radiology, Chinese PLA General Hospital, Beijing, China OBJECTIVES Changes in carotid plaque lipid-rich necrotic core (LRNC) as assessed by magnetic resonance imaging (MRI) were investigated in subjects who continued and discontinued statin therapy for 2 years after a prospective study. METHODS The Rosuvastatin Evaluation of Atherosclerotic Chinese Patients (REACH) study in 32 lipid treatment naïve subjects with LRNC showed a significant reduction in LRNC during 24 months (M) of rosuvastatin therapy. All subjects received a clinical follow-up (F/U) visit and a repeat carotid MRI scan at 48 M as planned REACH-F/U. Despite receiving a strong recommendation to continue the statin therapy at 24 M when REACH was completed, only 15 subjects continued taking statins (rosuva.¼9, simva.¼4 and atorva.¼2) in REACH-F/U and 17 discontinued. Lipids and LRNC, both in volume (V) and % (LRNC-V/Wall V100%), were compared between the statincontinued and -discontinued groups at 48 M. RESULTS There were no significant differences in demographic, clinical characteristics, lipids and plaque changes during 24 M in REACH between the statin-continued and -discontinued groups in REACH-F/U. Not surprisingly, at 48 M, Total-Cholesterol (C), LDL-C and triglycerides were significantly lower in subjects who continued statin than those discontinued (16343 vs. 20730 mg/dl, p¼0.002), (9336 vs. 13122 mg/dl, p¼0.001) and (8527 vs. 14365 mg/dl, p¼0.003), while HDL-C levels were similar. LRNC-V and %LRNC decreased significantly from 24 M in the statin-continued group (10176 mm3 at 24 M vs. 7665 mm 3 at 48 M, p¼0.001) and (17.311.9% at 24 M vs. 12.67.6% at 48 M, p¼0.04). By contrast, subjects who discontinued statin showed non-statistically significant increase in LRNC-V and %LRNC (10393 mm3 at 24 M vs. 112106 mm3 at 48 M, p¼0.4) and (15.411.3% at 24 Mvs. 16.711.4% at 48 M, p¼0.07). Furthermore, the changes in LRNC-V and %LRNC from 24 to 48 M were significantly different between the statin-continued and -discontinued groups in REACH-F/U (-2518 vs. 914 mm3, p<0.001) and (-4.6 8.2% vs. 1.32.8%, p¼0.009). CONCLUSIONS Continued statin therapy leads to continued decrease in LRNC, which indicates improved plaque stability. The REACH-F/U results provided vascular biological evidence to strongly support longterm statin therapy.
Li Hao,1,2 Jingquan Zhong1 1 The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital; 2School of Medicine, Shandong University, Jinan, China
METHODS In the trial, 41 patients who had intracardiac thrombus detected by transesophageal echocardiography (TEE) were enrolled. Among them, 19 patients received dabigatran 150 mg bid and the remaining 22 patients received warfarin based on the patients’ individual choice. Repeated TEE was performed at 3 months. The patients was assessed after 1 month and then 3 months in the clinic; meanwhile they were requested to contact the investigator immediately if symptoms developed that were suggestive of stroke, thromboembolism or major bleeding. All statistical analyses were conducted with SPSS Statistics version 17.0 software. The thrombus dissolution ability, represented by the ratio of decreased thrombus area to original area, was compared by Wilcoxon W test between the 2 groups. Difference with p value < 0.05 (2-sided) was considered statistically significant. RESULTS Mean age of the study population was 57.77.4 years, with 36 (87.8%) male and 17 (41.5%) patients who had persistent AF, with no differences between the 2 groups. Thrombus area ranges from 0.1 to 4.48 cm2 and the locations of thrombi were mainly in left atrial appendage (LAA). The thrombus area in warfarin group were larger than in dabigatran group (1.451.04 vs. 0.640.54, p < 0.05). Mean number of INR examination values obtained in the warfarin group was 10 during the therapy course. Time in therapeutic range of INR (TTR) was above 60%. Complete thrombus resolution was documented by repeated TEE in 17 patients in dabigatran group (17 of 19) and 17 patients in warfarin group (17 of 22). The ability of thrombus dissolution, represented by the ratio of decreased thrombus area to original area, was similar between the 2 groups (p > 0.05). Any bleeding, occurred in 7 patients receiving dabigatran and in 8 patients receiving warfarin. No major or fatal bleeding occurred in both two groups. One patient in the warfarin group experienced ischemic stroke. Four patients in the dabigatran group had gastrointestinal discomfort. Only one patient discontinued dabigatran for about two weeks and needed drug intervention, and after 3-month anticoagulation, a secondary TEE detected an increased thrombus. CONCLUSIONS Dabigatran has similar effect compared with warfarin for the treatment of intracardiac thrombus in patients with nonvalvular AF. Uninterrupted dabigatran is particularly essential and crucial for fibrinolysis and drug discontinuance would affect thrombus dissolution effect. It should be noticed that dabigatran lead to gastrointestinal discomfort event. GW26-e0675 Comparison of Ticagrelor with Clopidogrel in the Treatment of Patients with Acute Coronary Syndrome in Platelet Reactivity Jingjing Li, Xiaowen Geng, Jie Gao, Yilun Chen, Yihong Ren Department of Cardiovascular, General Hospital of PLA OBJECTIVES To compare the inhibitory effect of ticagrelor and clopidogrel on the platelet of patients with acute coronary syndrome(ACS) after percutaneous coronary artery intervention(PCI). METHODS 255 cases of patients with ACS admitted in our hospital from March 2014 to August 2014 were selected for this study, in which 85 cases were treated by ticagrelor and aspirin and the other 170 cases were treated by clopidogrel and aspirin respectively. All the patients were given PCI treatment, and the thrombelastography(TEG) were detected 2 days after PCI and oral administration of load dosage of antiplatelet drugs, the platelet inhibition ratio through ADP and AA pathway were observed and compared between two groups. RESULTS Adenosine diphosphate(ADP)-induced platelet inhibition ratio in clopidogrel group was significantly lower than that of in ticagrelor group (66.6025.57% vs 82.1018.87%, P<0.05). Arachidonic acid(AA)-induced platelet inhibition ratio in clopidgrel was similar to that of in ticagrelor group (88.7023.89% vs 90.3218.09%, P>0.05). There were significant differences between clopidogrel
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group and ticagrelor group in the percentages of patients with ADPinduced platelet inhibition ratio<30% (1.2% vs 8.2%, P<0.05). There were significant differences between clopidogrel group and ticagrelor group in the percentages of patients with ADP-induced platelet inhibition ratio <50% (29.4% vs 10.6%, P<0.05). There were also significant differences between clopidogrel group and ticagrelor group in the percentages of patients with ADP-induced platelet inhibition ratio>75% (41.8% vs 69.4%, P<0.05).
total cholesterol, Apoliprotein B compared to the maximal-dose simvastin 40mg or 80 mg. These results suggest that ezetimibe/simvastatin 10/10mg is comparable to the high-dose simvastatin 40mg or 80mg, however, the maximal dose of simvastatin can reduce the triglycerides effectively compared to low-dose simvastatin/ezetimibe. Two agents can reduce ApoB level and increase the anti-atherosclerosis lipidprotein ApoA-I, and two treatment strategies have same favorable effect on lipoprotein profiles.
CONCLUSIONS ① Ticagrelor had greater inhibitory effect on the patients with ACS after PCI than Clopidogrel. ② Higher residual platelet activity (HRPA) phenomenon also can be seen in the ticagrelor treatment patients, although that is even more in clopidogrel treatment patients.
GW26-e0494 Effectiveness and safety of tolvaptan in chinese heart failure patients with reduced left ventricular systolic function
GW26-e1002 A Meta-analysis of Randomized Clinical Trials of Dual Antiplatelet Therapy in Patients with Drug-Eluting Stent Implantation Jianbing ZHU, Junbo Ge Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, China OBJECTIVES The purpose of this study was to perform a meta-analysis comparing short-term versus long-term dual antiplatelet therapy (DAPT) to identify the optimal duration of DAPT in patients with DrugEluting Stent (DES) implantation. METHODS This study included 15,870 patients from 7 randomized clinical trials (RCT) comparing short-term DATP (S-DAPT) versus longterm DATP (L-DAPT) following drug-eluting stents. We examined the odds ratio (OR) and 95% confidence intervals (Cls) of clinically significant bleeding (CSB) and stent thrombosis as primary endpoints. Myocardial infarction, stroke, cardiovascular mortality and all-cause mortality were evaluated as secondary endpoints. RESULTS Compared with L-DAPT, S-DAPT had a decreased risk of CSB (OR: 0.57 [95% CI: 0.40 to 0.81]; p < 0.01). The rates of stent thrombosis (OR: 1.20 [95% CI: 0.77 to 1.88]; p > 0.05), myocardial infarction (OR: 1.13 [95% CI: 0.88 to 1.44]; p > 0.05), stroke (OR: 0.88 [95% CI: 0.57 to 1.36]; p > 0.05), cardiovascular mortality (OR: 0.99 [95% CI: 0.72 to 1.36]; p > 0.05) and all-cause mortality (OR: 0.93 [95% CI: 0.74 to 1.18]; p > 0.05) were similar. CONCLUSIONS S-DAPT for treatment in patients with DES implantation is associated with a significant reduction of CSB compared with L-DAPT. GW26-e4591 The lowering lipid efficacy of low-dose simvastatin and ezetimibe compared to high-dose simvastatin alone: A meta-analysis Ning Zhang, Qizhu Tang Renmin Hospital of Wuhan University, Wuhan 430060, China OBJECTIVES The ezetimibe/simvastatin combination tablet and highdose simvastatin monotherapy represent two major options for treatment of patients with hyercholesterolemia. The lowering lipid effect of direct comparative studies between ezetimibe/simvastatin (10/10mg) and high-dose simvastatin(40mg or 80mg) therapies have not been reported. To evaluate whether low-dose simvastatin/ezetimibe 10/ 10mg would achieve the same lowering lipid efficacy compared to simvastatin 40mg or 80mg in treatment of patients with dyslipidemia. METHODS Randomized controlled trials (RCTs) regarding to the patients with dyslipidemia in treatment of ezetimibe and simvastatin were retrieved in PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL). We also searched the reference lists of relevant papers. Data was extracted by two reviewers independently. Statistical analysis was performed using RevMan 5.2.
Lijin Zeng, Zhibin Chen, Jingguo Wu, Wen Yang, Zhenyu Li First Affiliated Hospital of Sun Yet-sen University OBJECTIVES To examine the efficacy and safety of tolvaptan in acute decompensated heart failure patients with reduced left ventricular systolic function. METHODS A total of 145 hospitalized acute decompensated heart failure patients were randomly assigned to either a tolvaptan(n¼79) or a control group(n¼66) which used conventional treatment only. Baseline clinical characteristics were not different between the two groups. We divided these patients based on the left ventricular ejection fraction (EF) by echocardiography. RESULTS There was no significant difference of daily urine volume between the tolvaptan and control groups in patients with preserved EF ( 50%).The urine volume was significantly higher in the tolvaptan group than in the control group in those with reduced EF (< 50%)(P < 0.05 ).In the safety profile, the incidence rate of thirst was higher in the tolvaptan group than that in control group (21.5% versus 7.6%, P<0.05). The incidence of hypernatremia( 150 mEq/L) in tolvaptan group was no significant difference than that in control group (6.3% versus 3.0%, P>0.05). CONCLUSIONS This study reveals that tolvaptan is more effective than conventional treatment in acute decompensated heart failure patients with reduced left ventricular systolic function and it is safety. GW26-e1084 Effects of Shensongyangxin capsule on heart rates variability and insomnia in maintenance hemodialysis patients Zhenda Zheng, Caihong Qu, Xiaoju Ma, Jianrui Zheng, Cailian Cheng the Third Affiliated Hospital of Sum Yat-sen University, Guangzhou OBJECTIVES To investigate the efficacy and safety of Shensongyangxin capsule (SSYX) on heart rate variability (HRV) and insomnia in maintenance hemodialysis patients. METHODS sixty-three maintenance hemodialysis patients in the third affiliated hospital of Sun Yat-Sen University from 2013 June to December were divided into two groups, SSYX treatment group(n¼33) and control group(n¼30). SSYX treatment group were received SSYX 4 capsules four times a day for eight weeks, all patients received 24-hholter test and Pittsburgh sleep quality index were measured at both baseline and eight weeks in these sixty-three patients. RESULTS SSYX can improve heart rate variability [SDNN (93.21.4) vs.(82.413.1) ms, SDNNi (41.212.8) vs. (28.412.2)ms, SDANNi (81.321.1) vs. (73.220.7)ms, RMSSD (28.313.2)vs.(21.811.9)ms, PNN50 (9.67.1) vs.(7.15.8)%, P<0.05], SSYX can decrease the incidence of arrhythmia [premature atrial contraction(60.6% vs.24.2%), atrial tachycardia (45.5% vs.12.1%), premature ventricular contraction(9.1% vs.3%), ventricular tachycardia(21.2% vs.9.1%), atrial-ventricular blocker (60.6% vs.24.2%), P<0.05], SSYX also improved sleep quality significantly[PSQI (6.282.12) vs.( 14.392.84), P<0.05]. There was no severe adverse events registered during the study.
RESULTS 8 RCTs including 202 high-dose simvastatin controls and 200 low-dose simvastatin / ezetimibe patients were enrolled in our meta-analysis. Low density lipoprotein - cholesterol (MD, -0.27; 95% CI, -3.82 to 3.28; P ¼0.88), high density lipoprotein-cholesterol (MD, 0.32; 95%CI, -1.32 to 1.95; P ¼0.88), the total cholesterol level (MD, 0.76; 95%CI, -4.14 to 5.65; P ¼0.76), Apolipoprotein B (MD, -1.70; 95 %CI, -7.10 to 3.71; P ¼0.54) and apolipoprotein A-I level (MD, -2.75; 95%CI, -9.72 to 4.23; P ¼0.44) were at the same level after the low-dose ezetimibe / simvastatin 10/10mg and simvastatin 40mg or 80 mg treatment respectively. However, the maximal dose of simvastatin can reduce the teriglyrides effectively compared to low-dose simvastatin/ezetimibe (MD, 14.35; 95%CI, 9.51 to 19.20; P <0.00001).
CONCLUSIONS Clinical use of SSYX was safe and effective for treating hemodialysis patients with decrease HRV and insomnia.
CONCLUSIONS Our study demonstrate ezetimibe/simvastatin 10/10mg can reach the same lowering lipid parameters such as LDL-C,
METHODS The data of routine coagulation assays from two aged cases treated with dabigatran etexilate were retrospectively reviewed,
GW26-e2949 Effects of dabigatran on coagulation assays in aged patients with atrial fibrillation : Two cases report Xiaoping Hou, Xuan Wei, Yanyan Li Air Force General Hospital of PLA OBJECTIVES To report the effects of dabigatran etexilate on routine coagulation assays in two aged patients with atrial fibrillation.
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OBJECTIVES Elevated remnant-lipoprotein cholesterol (RLP-C) levels are associated with an increased risk of ischemic heart disease. The concurrence of RLP-C measurement by different separation methods is not well-described. This analysis assessed RLP-C by 3 commonly used measurements including immunoseparation (IM [ApoA-I and ApoB-100 monoclonal antibodies]), vertical auto profile (VAP [IDLþVLDL3]) and Calculated RLP-C (Total cholesterol minus HDL-C minus LDL-C) methods using samples from a previously reported randomized, clinical trial.
GW26-e3950 Uninterrupted Dabigatran versus Warfarin in the Treatment of Intracardiac Thrombus in Patients with non-Valvular Atrial Fibrillation
METHODS This analysis assessed fasting RLP-C in hyperlipidemic patients (n¼2,382) treated with ezetimibe/simvastatin (E/S)10/20 mg, E/S þ niacin (N) 2g and N 2g during 24 weeks, and E/S 10/20 mg and E/S þ N 2g during 64 weeks. RLP-C levels, change from baseline and % change from baseline were evaluated by the IM, VAP, and Calculated methods. The relationships and agreement among the 3 methods used in the measurement of these parameters were assessed by Pearson correlation coefficients and Bland-Altman, respectively.
OBJECTIVES The oral direct thrombin inhibitor dabigatran has a predictable anticoagulant effect and may be an alternative medication to warfarin for non-valvular atrial fibrillation (AF) patients with intracardiac thrombus. The objective is to compare the dabigatran, administered at a fixed dose of 150 mg twice daily (bid) with dose-adjusted warfarin (with a target international normalized ratio INR level of 2.0 to 3.0).
RESULTS Cholesterol mass at baseline measured by the VAP and Calculated methods was w3-4X higher than by IM; all declined with treatment by 24 weeks with little further reduction at 64 weeks (see table). RLP-C change and % reduction from baseline were larger when measured by VAP versus Calculated and IM methods. Although the 3 methods were moderately to strongly correlated (r¼0.37-0.79) for RLP-C levels and changes, Bland-Altman plots showed little agreement between the methods for RLP-C levels but slightly better agreement for RLP-C changes (not shown). CONCLUSIONS RLP-C defined by IM, VAP and Calculated methods differs in mass and response to pharmacologic intervention. Given the relationship between RLP-C and IHD risk, standardization of methods is needed for RLP-C use in risk assessment.
GW26-e2366 Changes in Carotid Plaque Lipid Content in Subjects Who Continued and Discontinued Statin Therapy Ruixue Du, Ping Ye The Department of Geriatric Cardiology & Department of Radiology, Chinese PLA General Hospital, Beijing, China OBJECTIVES Changes in carotid plaque lipid-rich necrotic core (LRNC) as assessed by magnetic resonance imaging (MRI) were investigated in subjects who continued and discontinued statin therapy for 2 years after a prospective study. METHODS The Rosuvastatin Evaluation of Atherosclerotic Chinese Patients (REACH) study in 32 lipid treatment naïve subjects with LRNC showed a significant reduction in LRNC during 24 months (M) of rosuvastatin therapy. All subjects received a clinical follow-up (F/U) visit and a repeat carotid MRI scan at 48 M as planned REACH-F/U. Despite receiving a strong recommendation to continue the statin therapy at 24 M when REACH was completed, only 15 subjects continued taking statins (rosuva.¼9, simva.¼4 and atorva.¼2) in REACH-F/U and 17 discontinued. Lipids and LRNC, both in volume (V) and % (LRNC-V/Wall V100%), were compared between the statincontinued and -discontinued groups at 48 M. RESULTS There were no significant differences in demographic, clinical characteristics, lipids and plaque changes during 24 M in REACH between the statin-continued and -discontinued groups in REACH-F/U. Not surprisingly, at 48 M, Total-Cholesterol (C), LDL-C and triglycerides were significantly lower in subjects who continued statin than those discontinued (16343 vs. 20730 mg/dl, p¼0.002), (9336 vs. 13122 mg/dl, p¼0.001) and (8527 vs. 14365 mg/dl, p¼0.003), while HDL-C levels were similar. LRNC-V and %LRNC decreased significantly from 24 M in the statin-continued group (10176 mm3 at 24 M vs. 7665 mm 3 at 48 M, p¼0.001) and (17.311.9% at 24 M vs. 12.67.6% at 48 M, p¼0.04). By contrast, subjects who discontinued statin showed non-statistically significant increase in LRNC-V and %LRNC (10393 mm3 at 24 M vs. 112106 mm3 at 48 M, p¼0.4) and (15.411.3% at 24 Mvs. 16.711.4% at 48 M, p¼0.07). Furthermore, the changes in LRNC-V and %LRNC from 24 to 48 M were significantly different between the statin-continued and -discontinued groups in REACH-F/U (-2518 vs. 914 mm3, p<0.001) and (-4.6 8.2% vs. 1.32.8%, p¼0.009). CONCLUSIONS Continued statin therapy leads to continued decrease in LRNC, which indicates improved plaque stability. The REACH-F/U results provided vascular biological evidence to strongly support longterm statin therapy.
Li Hao,1,2 Jingquan Zhong1 1 The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital; 2School of Medicine, Shandong University, Jinan, China
METHODS In the trial, 41 patients who had intracardiac thrombus detected by transesophageal echocardiography (TEE) were enrolled. Among them, 19 patients received dabigatran 150 mg bid and the remaining 22 patients received warfarin based on the patients’ individual choice. Repeated TEE was performed at 3 months. The patients was assessed after 1 month and then 3 months in the clinic; meanwhile they were requested to contact the investigator immediately if symptoms developed that were suggestive of stroke, thromboembolism or major bleeding. All statistical analyses were conducted with SPSS Statistics version 17.0 software. The thrombus dissolution ability, represented by the ratio of decreased thrombus area to original area, was compared by Wilcoxon W test between the 2 groups. Difference with p value < 0.05 (2-sided) was considered statistically significant. RESULTS Mean age of the study population was 57.77.4 years, with 36 (87.8%) male and 17 (41.5%) patients who had persistent AF, with no differences between the 2 groups. Thrombus area ranges from 0.1 to 4.48 cm2 and the locations of thrombi were mainly in left atrial appendage (LAA). The thrombus area in warfarin group were larger than in dabigatran group (1.451.04 vs. 0.640.54, p < 0.05). Mean number of INR examination values obtained in the warfarin group was 10 during the therapy course. Time in therapeutic range of INR (TTR) was above 60%. Complete thrombus resolution was documented by repeated TEE in 17 patients in dabigatran group (17 of 19) and 17 patients in warfarin group (17 of 22). The ability of thrombus dissolution, represented by the ratio of decreased thrombus area to original area, was similar between the 2 groups (p > 0.05). Any bleeding, occurred in 7 patients receiving dabigatran and in 8 patients receiving warfarin. No major or fatal bleeding occurred in both two groups. One patient in the warfarin group experienced ischemic stroke. Four patients in the dabigatran group had gastrointestinal discomfort. Only one patient discontinued dabigatran for about two weeks and needed drug intervention, and after 3-month anticoagulation, a secondary TEE detected an increased thrombus. CONCLUSIONS Dabigatran has similar effect compared with warfarin for the treatment of intracardiac thrombus in patients with nonvalvular AF. Uninterrupted dabigatran is particularly essential and crucial for fibrinolysis and drug discontinuance would affect thrombus dissolution effect. It should be noticed that dabigatran lead to gastrointestinal discomfort event. GW26-e0675 Comparison of Ticagrelor with Clopidogrel in the Treatment of Patients with Acute Coronary Syndrome in Platelet Reactivity Jingjing Li, Xiaowen Geng, Jie Gao, Yilun Chen, Yihong Ren Department of Cardiovascular, General Hospital of PLA OBJECTIVES To compare the inhibitory effect of ticagrelor and clopidogrel on the platelet of patients with acute coronary syndrome(ACS) after percutaneous coronary artery intervention(PCI). METHODS 255 cases of patients with ACS admitted in our hospital from March 2014 to August 2014 were selected for this study, in which 85 cases were treated by ticagrelor and aspirin and the other 170 cases were treated by clopidogrel and aspirin respectively. All the patients were given PCI treatment, and the thrombelastography(TEG) were detected 2 days after PCI and oral administration of load dosage of antiplatelet drugs, the platelet inhibition ratio through ADP and AA pathway were observed and compared between two groups. RESULTS Adenosine diphosphate(ADP)-induced platelet inhibition ratio in clopidogrel group was significantly lower than that of in ticagrelor group (66.6025.57% vs 82.1018.87%, P<0.05). Arachidonic acid(AA)-induced platelet inhibition ratio in clopidgrel was similar to that of in ticagrelor group (88.7023.89% vs 90.3218.09%, P>0.05). There were significant differences between clopidogrel
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group and ticagrelor group in the percentages of patients with ADPinduced platelet inhibition ratio<30% (1.2% vs 8.2%, P<0.05). There were significant differences between clopidogrel group and ticagrelor group in the percentages of patients with ADP-induced platelet inhibition ratio <50% (29.4% vs 10.6%, P<0.05). There were also significant differences between clopidogrel group and ticagrelor group in the percentages of patients with ADP-induced platelet inhibition ratio>75% (41.8% vs 69.4%, P<0.05).
total cholesterol, Apoliprotein B compared to the maximal-dose simvastin 40mg or 80 mg. These results suggest that ezetimibe/simvastatin 10/10mg is comparable to the high-dose simvastatin 40mg or 80mg, however, the maximal dose of simvastatin can reduce the triglycerides effectively compared to low-dose simvastatin/ezetimibe. Two agents can reduce ApoB level and increase the anti-atherosclerosis lipidprotein ApoA-I, and two treatment strategies have same favorable effect on lipoprotein profiles.
CONCLUSIONS ① Ticagrelor had greater inhibitory effect on the patients with ACS after PCI than Clopidogrel. ② Higher residual platelet activity (HRPA) phenomenon also can be seen in the ticagrelor treatment patients, although that is even more in clopidogrel treatment patients.
GW26-e0494 Effectiveness and safety of tolvaptan in chinese heart failure patients with reduced left ventricular systolic function
GW26-e1002 A Meta-analysis of Randomized Clinical Trials of Dual Antiplatelet Therapy in Patients with Drug-Eluting Stent Implantation Jianbing ZHU, Junbo Ge Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, China OBJECTIVES The purpose of this study was to perform a meta-analysis comparing short-term versus long-term dual antiplatelet therapy (DAPT) to identify the optimal duration of DAPT in patients with DrugEluting Stent (DES) implantation. METHODS This study included 15,870 patients from 7 randomized clinical trials (RCT) comparing short-term DATP (S-DAPT) versus longterm DATP (L-DAPT) following drug-eluting stents. We examined the odds ratio (OR) and 95% confidence intervals (Cls) of clinically significant bleeding (CSB) and stent thrombosis as primary endpoints. Myocardial infarction, stroke, cardiovascular mortality and all-cause mortality were evaluated as secondary endpoints. RESULTS Compared with L-DAPT, S-DAPT had a decreased risk of CSB (OR: 0.57 [95% CI: 0.40 to 0.81]; p < 0.01). The rates of stent thrombosis (OR: 1.20 [95% CI: 0.77 to 1.88]; p > 0.05), myocardial infarction (OR: 1.13 [95% CI: 0.88 to 1.44]; p > 0.05), stroke (OR: 0.88 [95% CI: 0.57 to 1.36]; p > 0.05), cardiovascular mortality (OR: 0.99 [95% CI: 0.72 to 1.36]; p > 0.05) and all-cause mortality (OR: 0.93 [95% CI: 0.74 to 1.18]; p > 0.05) were similar. CONCLUSIONS S-DAPT for treatment in patients with DES implantation is associated with a significant reduction of CSB compared with L-DAPT. GW26-e4591 The lowering lipid efficacy of low-dose simvastatin and ezetimibe compared to high-dose simvastatin alone: A meta-analysis Ning Zhang, Qizhu Tang Renmin Hospital of Wuhan University, Wuhan 430060, China OBJECTIVES The ezetimibe/simvastatin combination tablet and highdose simvastatin monotherapy represent two major options for treatment of patients with hyercholesterolemia. The lowering lipid effect of direct comparative studies between ezetimibe/simvastatin (10/10mg) and high-dose simvastatin(40mg or 80mg) therapies have not been reported. To evaluate whether low-dose simvastatin/ezetimibe 10/ 10mg would achieve the same lowering lipid efficacy compared to simvastatin 40mg or 80mg in treatment of patients with dyslipidemia. METHODS Randomized controlled trials (RCTs) regarding to the patients with dyslipidemia in treatment of ezetimibe and simvastatin were retrieved in PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL). We also searched the reference lists of relevant papers. Data was extracted by two reviewers independently. Statistical analysis was performed using RevMan 5.2.
Lijin Zeng, Zhibin Chen, Jingguo Wu, Wen Yang, Zhenyu Li First Affiliated Hospital of Sun Yet-sen University OBJECTIVES To examine the efficacy and safety of tolvaptan in acute decompensated heart failure patients with reduced left ventricular systolic function. METHODS A total of 145 hospitalized acute decompensated heart failure patients were randomly assigned to either a tolvaptan(n¼79) or a control group(n¼66) which used conventional treatment only. Baseline clinical characteristics were not different between the two groups. We divided these patients based on the left ventricular ejection fraction (EF) by echocardiography. RESULTS There was no significant difference of daily urine volume between the tolvaptan and control groups in patients with preserved EF ( 50%).The urine volume was significantly higher in the tolvaptan group than in the control group in those with reduced EF (< 50%)(P < 0.05 ).In the safety profile, the incidence rate of thirst was higher in the tolvaptan group than that in control group (21.5% versus 7.6%, P<0.05). The incidence of hypernatremia( 150 mEq/L) in tolvaptan group was no significant difference than that in control group (6.3% versus 3.0%, P>0.05). CONCLUSIONS This study reveals that tolvaptan is more effective than conventional treatment in acute decompensated heart failure patients with reduced left ventricular systolic function and it is safety. GW26-e1084 Effects of Shensongyangxin capsule on heart rates variability and insomnia in maintenance hemodialysis patients Zhenda Zheng, Caihong Qu, Xiaoju Ma, Jianrui Zheng, Cailian Cheng the Third Affiliated Hospital of Sum Yat-sen University, Guangzhou OBJECTIVES To investigate the efficacy and safety of Shensongyangxin capsule (SSYX) on heart rate variability (HRV) and insomnia in maintenance hemodialysis patients. METHODS sixty-three maintenance hemodialysis patients in the third affiliated hospital of Sun Yat-Sen University from 2013 June to December were divided into two groups, SSYX treatment group(n¼33) and control group(n¼30). SSYX treatment group were received SSYX 4 capsules four times a day for eight weeks, all patients received 24-hholter test and Pittsburgh sleep quality index were measured at both baseline and eight weeks in these sixty-three patients. RESULTS SSYX can improve heart rate variability [SDNN (93.21.4) vs.(82.413.1) ms, SDNNi (41.212.8) vs. (28.412.2)ms, SDANNi (81.321.1) vs. (73.220.7)ms, RMSSD (28.313.2)vs.(21.811.9)ms, PNN50 (9.67.1) vs.(7.15.8)%, P<0.05], SSYX can decrease the incidence of arrhythmia [premature atrial contraction(60.6% vs.24.2%), atrial tachycardia (45.5% vs.12.1%), premature ventricular contraction(9.1% vs.3%), ventricular tachycardia(21.2% vs.9.1%), atrial-ventricular blocker (60.6% vs.24.2%), P<0.05], SSYX also improved sleep quality significantly[PSQI (6.282.12) vs.( 14.392.84), P<0.05]. There was no severe adverse events registered during the study.
RESULTS 8 RCTs including 202 high-dose simvastatin controls and 200 low-dose simvastatin / ezetimibe patients were enrolled in our meta-analysis. Low density lipoprotein - cholesterol (MD, -0.27; 95% CI, -3.82 to 3.28; P ¼0.88), high density lipoprotein-cholesterol (MD, 0.32; 95%CI, -1.32 to 1.95; P ¼0.88), the total cholesterol level (MD, 0.76; 95%CI, -4.14 to 5.65; P ¼0.76), Apolipoprotein B (MD, -1.70; 95 %CI, -7.10 to 3.71; P ¼0.54) and apolipoprotein A-I level (MD, -2.75; 95%CI, -9.72 to 4.23; P ¼0.44) were at the same level after the low-dose ezetimibe / simvastatin 10/10mg and simvastatin 40mg or 80 mg treatment respectively. However, the maximal dose of simvastatin can reduce the teriglyrides effectively compared to low-dose simvastatin/ezetimibe (MD, 14.35; 95%CI, 9.51 to 19.20; P <0.00001).
CONCLUSIONS Clinical use of SSYX was safe and effective for treating hemodialysis patients with decrease HRV and insomnia.
CONCLUSIONS Our study demonstrate ezetimibe/simvastatin 10/10mg can reach the same lowering lipid parameters such as LDL-C,
METHODS The data of routine coagulation assays from two aged cases treated with dabigatran etexilate were retrospectively reviewed,
GW26-e2949 Effects of dabigatran on coagulation assays in aged patients with atrial fibrillation : Two cases report Xiaoping Hou, Xuan Wei, Yanyan Li Air Force General Hospital of PLA OBJECTIVES To report the effects of dabigatran etexilate on routine coagulation assays in two aged patients with atrial fibrillation.